Yesterday I triaged from 7-3 dayshift in our 17 bed ER. It was extremely busy, as usual lately. We kept a full ER and a waiting to come back list of 10-20 patients all day. Today my supervisor called me to let me know that apparently someone that I triaged for low back pain and nausea and vomiting for 2 weeks , a middle aged gentleman, and marked non-urgent coded in the waiting area after I left.
Ever since that phone call this am I have been a nervous wreck. I trust my triage skills, although I triaged so many people yesterday that I honestly cannot remember this particular patient at all. I know if I had seen or heard something on exam and interview I would have brought him straight back, even if I would have had to placed him in the hallway, which already had patients in it. A little bit ago the hospital left a message on my machine to meet with hospital lawyers on Thursday.
I am completely freaking out. What if I missed something,
will I ever be able to triage again without being scared of missing something? I realize we can't have a crystal ball to look in to see who has death lurking over their shoulder, but I still feel awful. Has this ever happened to anyone else? How do you go on without constantly second guessing yourself? Any respones will greatly be appreciated, as I am currently breaking out in one giant zit and getting a giant migraine from the stress. :stone :o
I read posts like this and thank my lucky stars that the two times recently someone came in with vague, 2 week old sx, we had room and they went back right away. Both were mid 50's. One was a discecting AAA, the one last night was an acute MI that went from being 7/10 pain to 1/10 with 1 NTG. He was talking to his wife when his eyes rolled back and he started going towards the light. One good thump, one shock and LIDO and he came around.
Both presented to triage with vague pains off/on for as while. Neither had any risk factors. If we had been busy, both would have probably coded in the waiting room.
Like many posters have said. We do not have a crystal ball. We use our knowledge and experience and make the best decision, based on the information that is given to us by the historian (pt or family member). We have to drag the info out of many of them, and when we decide they can wait, nothing bad happens to them. It is a fact, but , sometimes one will slip through that should have gone back earlier.
Don't beat yourself up over this. If you were not capable of doing the job, you would not be there. Just look at the chart, and perhaps that will help you remember. Tell only what you remember, do not let them put words inyour mouth.
oh how terrible for you. I agree with the above though , don't beat yourself up and trust your skills.You did what any resonalbe and resonsible person would do.
Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.
I feel for you having been in a similar situation of sorts. You lose all confidence and the last thing you want to do is return. But return you MUST. You sound like a thorough and caring nurse to me. Some things are WTF situations and sometimes people die despite our BEST efforts to help them. These cases stymie us, cause us to step back and wonder WHY we do what we do. Don't let it defeat and demoralize you. Like said above, take good care of yourself and be extra kind to yourself. Each day will get a little bit easier as time goes by. Learn what you can (if there is anything) from the situation, and work hard to move on. Don't be afraid to take advantage of any counseling you can get, either. It can't hurt! Take care and good luck!
In our ER, any report of chest pain is considered emergent, no matter what. As a student I tend to err on the side of caution. I figure you can always downgrade someone if it turns out to be nothing. But we also only have one triage nurse and with so many patients coming in, I can see how something may be missed. The ER coordinator has been trying to get a second triage nurse for this very reason.
There but for the grace of God goes any one of us..I know I would have triaged it as non urgent. Just on the basis of a 2 week history you would think you were safe for at least another hour, or more.
I am so sorry you have to go through this, remember that you did not make an error. It was this man's time, and if he had coded in the trauma room you may not have been able to save him.
Well said, canoehead...."There but for the grace of God go I" as an ER nurse with 15 plus years of experience I know just how you feel, defib queen. Triage is the toughest job in the hospital. Hang in there! I am praying for you.
Thanks everyone, these posts have really helped ease my mind somewhat. When more details are available to me I will let you all know what the final diagnosis was, I'm pretty sure they sent the guy for autopsy.
As for doing something nice for myself, they called wanting me to work today, and I said no, I'm spending this day with my daughter. Thank you all so very much.
Just wanted to tell you that my prayers are with you. I agree you are a good and caring nurse or you would not be second guessing yourself. I recently had a relative 50 and very healthy die suddenly from what was thought to be the flu. She had just nursed her husband through the same symptoms. No one could have known. Just wanted you to know that noone in our family blames any medical proffesional for missing it. It wasnt there to see. Take care of you.
:o
Burnt Out, ASN, RN
647 Posts
i am not an er nurse, but like it has been said, we don't have x-ray vision........besides.....he had been hurting for 2 weeks?!
just go by your notes........:kiss ....((((hugs))))
p.s. thank you dr. kate!!!!!!!